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Hansen PS, Graversen M, Detlefsen S, Mortensen MB. Review on treatment of pleural metastasis and malignant pleural effusion with Pressurized IntraThoracic Aerosol Chemotherapy (PITAC). Pleura Peritoneum 2024; 9:47-53. [PMID: 38948327 PMCID: PMC11211649 DOI: 10.1515/pp-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/05/2024] [Indexed: 07/02/2024] Open
Abstract
Background Malignant pleural effusion (MPE) is a common and debilitating condition seen in advanced cancer disease, and life-expectancy is short. Symptoms include pain and severe shortness of breath. Current first-line treatment options include pleural drainage using catheters as well as pleurodesis. However, these treatment modalities are often inefficient and patients need repeated procedures. Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) is a minimally invasive procedure, where antineoplastic agents are nebulized under pressure into the pleural space. Content We present the preliminary safety, feasibility, and response assessment data for PITAC based on a comprehensive literature review. Summary Five retrospective studies reported data on 38 PITACs in 21 patients. Data were heterogeneous and incomplete on several important aspects such as procedure, safety, local effect and long-term outcomes. PITAC seems technically feasible with a low risk of complications and may provide some reduction in MPE in selected cases. Outlook PITAC seems feasible, but prospective phase I and II studies are needed to define safety, indications, and efficacy.
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Affiliation(s)
- Pernille Schjødt Hansen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
| | - Martin Graversen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Department of Surgery, HPB and Upper GI Section, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Michael Bau Mortensen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Department of Surgery, HPB and Upper GI Section, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Zhou H, Wang Q, Jiao L, Bi L, Sang S, Han Y, Gan S, Liu R, A G, Gong Y. Intrapleural injection of brucea javanica oil emulsion provided a long-term benefits in patient with malignant pleural effusion from pleural mesothelioma: A case report. Explore (NY) 2024; 20:126-129. [PMID: 37286465 DOI: 10.1016/j.explore.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a severe form of cancer that originates from mesothelium cells. Around 54-90% of mesotheliomas are associated with pleural effusions. Brucea Javanica Oil Emulsion (BJOE) is the processed oil derived from the seeds of Brucea javanica, which has shown potential as a treatment option for several types of cancer. Here, we present a case study of a MPM patient with malignant pleural effusion who received intrapleural injection of BJOE. The treatment resulted in the complete response of pleural effusion and chest tightness. While the precise mechanisms underlying the therapeutic effects of BJOE for pleural effusion are not yet fully understood, it has demonstrated a satisfactory clinical response without significant adverse effects.
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Affiliation(s)
- Hailun Zhou
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Qin Wang
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Lijing Jiao
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Ling Bi
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Shuliu Sang
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Yang Han
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Shanshan Gan
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Ruichao Liu
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Geer A
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Yabin Gong
- Department of Oncology of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine.
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Zhang Y, Li N, Li R, Gu Y, Liu X, Zhang S. Predicting survival for patients with mesothelioma: development of the PLACE prognostic model. BMC Cancer 2023; 23:698. [PMID: 37495975 PMCID: PMC10369846 DOI: 10.1186/s12885-023-11180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION The overall survival of patients with mesothelioma is poor and heterogeneous. At present, the prediction model for Chinese patients needs to be improved. We sought to investigate predictors of survival in malignant pleural mesothelioma and develop prognostic prediction models. METHODS This Two-center retrospective cohort study recruited patients with pathologically diagnosed mesothelioma at Beijing Chao-Yang Hospital and Beijing Tong-Ren Hospital. We developed a new prognostic prediction model based on COX multivariable analysis using data from patients who were recruited from June 1, 2010 to July 1, 2021 in Beijing Chao-Yang Hospital (n = 95, development cohort) and validated this model using data from patients recruited from July 18, 2014 to May 9, 2022 in Beijing Tong-Ren Hospital (n = 23, validation cohort). Receiver operating characteristic analysis was used to estimate model accuracy. RESULTS The parameters in this new model included PLT > 289.5(10^9/L) (1 point), Lymphocyte > 1.785(10^9/L) (-1point), Age > 73 years old (1 point), Calcium > 2.145(mmol/L) (-1point), Eastern Cooperative Oncology Group performance status (ECOG PS) > 2 (2 points). When the sum of scores < 0, it is recognized as a low-risk group; when the score is 0 ~ 3, it is recognized as a high-risk group. The survival rate of patients in the high-risk group was significantly lower than that in the low-risk group (hazard ratio [HR], 3.878; 95% confidence interval [CI], 2.226-6.755; P < 0.001). The validation group had similar results (HR,3.574; 95%CI,1.064-12.001; P = 0.039). Furthermore, the areas under the curve 6 months after diagnosis in the two cohorts were 0.900 (95% CI: 0.839-0.962) and 0.761 (95% CI: 0.568-0.954) for development and validation cohorts, respectively. CONCLUSION We developed a simple, clinically relevant prognostic prediction model for PLACE by evaluating five variables routinely tested at the time of diagnosis. The predictive model can differentiate patients of Chinese ethnicity into different risk groups and further guide prognosis.
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Affiliation(s)
- Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Institute of Geriatric Medicine, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Nan Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
| | - Ran Li
- Department of Respiratory and Critical Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Yumei Gu
- Department of Pathology, Beijing Chao-Yang Hospital , Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China.
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Farahmand P, Gyuraszova K, Rooney C, Raffo-Iraolagoitia XL, Jayasekera G, Hedley A, Johnson E, Chernova T, Malviya G, Hall H, Monteverde T, Blyth K, Duffin R, Carlin LM, Lewis D, Le Quesne J, MacFarlane M, Murphy DJ. Asbestos accelerates disease onset in a genetic model of malignant pleural mesothelioma. FRONTIERS IN TOXICOLOGY 2023; 5:1200650. [PMID: 37441092 PMCID: PMC10333928 DOI: 10.3389/ftox.2023.1200650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Hypothesis: Asbestos-driven inflammation contributes to malignant pleural mesothelioma beyond the acquisition of rate-limiting mutations. Methods: Genetically modified conditional allelic mice that were previously shown to develop mesothelioma in the absence of exposure to asbestos were induced with lentiviral vector expressing Cre recombinase with and without intrapleural injection of amosite asbestos and monitored until symptoms required euthanasia. Resulting tumours were examined histologically and by immunohistochemistry for expression of lineage markers and immune cell infiltration. Results: Injection of asbestos dramatically accelerated disease onset and end-stage tumour burden. Tumours developed in the presence of asbestos showed increased macrophage infiltration. Pharmacological suppression of macrophages in mice with established tumours failed to extend survival or to enhance response to chemotherapy. Conclusion: Asbestos-driven inflammation contributes to the severity of mesothelioma beyond the acquisition of rate-limiting mutations, however, targeted suppression of macrophages in established epithelioid mesothelioma showed no therapeutic benefit.
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Affiliation(s)
- Pooyeh Farahmand
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Claire Rooney
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Respiratory Medicine, Royal Infirmary, Glasgow, United Kingdom
| | | | - Geeshath Jayasekera
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Ann Hedley
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Emma Johnson
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Tatyana Chernova
- MRC Toxicology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Gaurav Malviya
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Holly Hall
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Tiziana Monteverde
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kevin Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Rodger Duffin
- Centre for Inflammation Research, Edinburgh, United Kingdom
| | - Leo M. Carlin
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - David Lewis
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - John Le Quesne
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
- Department of Histopathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Marion MacFarlane
- MRC Toxicology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Daniel J. Murphy
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- CRUK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
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He C, Tu D, Zhang T, Zhang Q, Zhang Q, Kang D, Wang Y, Li Y, Zhang B, Han S, Li H. Malignant pleural mesothelioma with constrictive pericarditis as the first manifestation: A case report. Clin Case Rep 2023; 11:e7555. [PMID: 37351350 PMCID: PMC10282120 DOI: 10.1002/ccr3.7555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
Pleural mesothelioma (PM) with pericardial involvement is extremely rare. We now report a rare case of malignant PM with constrictive pericarditis as the first presentation. A 59-year-old male diagnosed with constrictive pericarditis underwent pericardiectomy and pericardial pathology revealed mesothelial hyperplasia. Eight months after surgery, the patient was admitted to the hospital with chest tightness and wheezing for 5 days. Computed tomography scan of the chest showed a left lung expansion insufficiency, limited bilateral pleural thickening, pericardial thickening with a small amount of pericardial effusion, and multiple enlarged lymph nodes in the mediastinum, bilateral supraclavicular fossa, bilateral cervical roots, and right axilla. The pleural malignancy should be possibly considered. Pathology after pleural puncture showed malignant PM. Pathology after left supraclavicular lymph node puncture biopsy showed metastatic malignant mesothelioma. The diagnosis of this patient was clear. Although malignant PM rarely involves the pericardial constriction, we cannot ignore the fact that malignant PM involves the pericardium. The patient has been diagnosed with constrictive pericarditis, accompanied by pleural thickening and pleural effusion. Without other pathogenic factors, pleural biopsy should be aggressively performed in patients with constrictive pericarditis to determine the cause.
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Affiliation(s)
- Cheng‐Peng He
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Di‐Wei Tu
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Ting‐Wei Zhang
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Qian Zhang
- Department of PathologyBinzhou Medical College Affiliated HospitalBinzhouChina
| | - Qiang Zhang
- Department of ImagingBinzhou Medical College Affiliated HospitalBinzhouChina
| | - Di Kang
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Ying‐Ying Wang
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Ying‐Ying Li
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Bin Zhang
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Sha‐Sha Han
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
| | - Hong‐Bo Li
- Department of Respiratory and Critical Care MedicineBinzhou Medical College Affiliated Hospital (First Clinical Medical College)BinzhouChina
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Zhang Y, Li J, Zhang S. Prognostic significance of inflammation-related and electrolyte laboratory variables in patients with malignant pleural mesothelioma. Front Med (Lausanne) 2023; 10:1099685. [PMID: 37089600 PMCID: PMC10114925 DOI: 10.3389/fmed.2023.1099685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectiveMalignant pleural mesothelioma (MPM) is a kind of pleural cancer characterized by low incidence but high invasiveness. There is heterogeneity in survival among patients with MPM. Inflammation-related and electrolyte laboratory variables were previously reported as potential predictors of survival. We evaluated the relationship between overall survival and pre-treatment biomarkers.Materials and methodsPatients diagnosed with MPM in Beijing Chaoyang Hospital for more than 10 years were screened for this study. All basic, clinical, radiologic and laboratory variables were collected. The COX univariable and multivariable analysis were used to explore prognostic related risk factors.ResultsNinety patients with MPM were included. The median follow-up of all patients was 57 months [interquartile range (IQR): 27–100 months]. The median survival time was 24 months (IQR: 12–52 months). Univariate survival analyses indicated that age, Eastern Cooperative Oncology Group Performance Status, treatment, erythrocyte sedimentation rate, calcium, lymphocyte, hemoglobin, platelet-to-lymphocyte ratio (PLR), and monocyte-to-white blood cell ratio (MWR) were significantly related to survival. Multivariable analysis demonstrated that age [hazard ratio (HR), 2.548; 95% confidence interval (CI) 1.145–5.666; p = 0.022], calcium (HR, 0.480; 95% CI 0.270–0.855; p = 0.013), PLR (HR, 2.152; 95% CI 1.163–3.981; p = 0.015), and MWR (HR, 3.360; 95% CI 1.830–6.170; p < 0.001) might have a significant impact on the prognosis.ConclusionCalcium, MWR, and PLR might be related to the prognosis of MPM patients. Analyzing the relationship between the results of inflammation-related and electrolyte laboratory variables in peripheral blood and prognosis could help clinicians evaluate the situation of patients.
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Affiliation(s)
| | - Jie Li
- *Correspondence: Shu Zhang, ; Jie Li,
| | - Shu Zhang
- *Correspondence: Shu Zhang, ; Jie Li,
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Qureshi M, Thapa B, Muruganandan S. A Narrative Review-Management of Malignant Pleural Effusion Related to Malignant Pleural Mesothelioma. Heart Lung Circ 2023; 32:587-595. [PMID: 36925448 DOI: 10.1016/j.hlc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive, almost universally fatal cancer with limited therapeutic options. Despite efforts, a real breakthrough in treatment and outcomes has been elusive. Pleural effusion with significant breathlessness and pain is the most typical presentation of individuals with MPM. Although thoracentesis provides relief of breathlessness, most such pleural effusions recur rapidly, and a definitive procedure is often required to prevent a recurrence. Unfortunately, the optimal treatment modality for individuals with recurrent MPM-related effusion is unclear, and considerable variation exists in practice. In addition, non-expandable lung is common in pleural effusions due to MPM and makes effective palliation of symptoms more difficult. This review delves into the latest advances in the available management options (both surgical and non-surgical) for dealing with pleural effusion and non-expandable lung related to MPM. We discuss factors that determine the choice of definitive procedures that need to be tailored to the individual patient.
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Affiliation(s)
- Maryum Qureshi
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia.
| | - Bibhusal Thapa
- Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Hospital, Melbourne, Vic, Australia; School of Medicine, Health Sciences, Dentistry, University of Melbourne, Vic, Australia
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Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology. Cancers (Basel) 2022; 14:cancers14061415. [PMID: 35326567 PMCID: PMC8946533 DOI: 10.3390/cancers14061415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The pleura is a cavity whose pathology ranges from simple fluid accumulation to tumor development, all inducing important consequences in patents health, and usually having an important association with local inflammation. Understanding the pathophysiology of pleural inflammation helps the development of the correct treatment strategies and opens new windows in pleural research. Thus, the aim of this review is to present the etiologies and the pathophysiological mechanisms of pleural inflammation with a special interest in their role on tumor development and diagnosis. Abstract Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy.
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Muruganandan S, Duong V. Malignant Pleural Effusion in Malignant Pleural Mesothelioma: An Innocent Bystander? Chest 2021; 160:1602-1603. [PMID: 34743845 DOI: 10.1016/j.chest.2021.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Victor Duong
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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